Understanding the cascade of care and predictors of treatment success among patients with hepatitis C - A prospective study at a tertiary care center in India.

Objectives: In India, 6-12 million people experience chronic hepatitis C infection, which can lead to complications such as liver cirrhosis and hepatocellular carcinoma. Despite free diagnostic and treatment services under the national program, treatment initiation is frequently delayed, and patient retention is sub-optimal. The study aims to identify the factors influencing the cascade of care and assess the predictors of treatment success. Methods: A hospital-based prospective longitudinal study was conducted among adult patients with hepatitis C. All patients with a detectable viral load who chose to initiate treatment in our center were enrolled and prescribed direct-acting antiviral drugs. They were observed throughout the treatment, and sustained viral response was measured at 12 weeks post-treatment. Data were analyzed using suitable statistical tests and a multivariable logistic regression to find the predictors of treatment success. Results: Of 761 patients who screened positive for viral hepatitis, 600 had detectable hepatitis C virus RNA. Among the 600 patients, only 64.27% (385) initiated the treatment. Of 385 patients, 77.4% underwent a viral load assay within 1 week of the screening test, whereas 78.4% started treatment within 1 month of hepatitis C virus RNA detection. Although 78.9% of patients completed the treatment, only 52.9% of patients underwent Sustained Viral Response testing. Among those tested, 92.6% achieved Sustained Viral Response. Age (adjusted odds ratio [AOR]: 0.95; 95% confidence interval [CI]: 0.92-0.98), intravenous drug use (AOR: 0.18; 95% CI: 0.06-0.52), cirrhosis (AOR: 0.28; 95% CI: 0.10-0.77), and Serum albumin levels (AOR: 2.05; 95% CI: 1.02-4.12) emerged as significant predictors of treatment success. Conclusions: Significant attrition of patients from screening to Sustained Viral Response testing highlights the gaps in the care continuum. Delayed diagnosis and treatment initiation further exacerbate the situation. Despite these challenges, direct-acting antivirals offer hope for successful treatment. Age, intravenous drug use, cirrhosis, and S. albumin levels emerged as significant predictors of treatment success.